Idaho Dept of Health & Welfare Reg 6 Cmh Bf C

NPI #1710019476 in Blackfoot, Idaho

Provider Information

NPI Number: 1710019476
Entity Type: Organization
Organization Name: Idaho Dept of Health & Welfare Reg 6 Cmh Bf C
Primary Specialty: Clinic/Center - Adolescent and Children Mental Health
Enumeration Date: Mar 9, 2007
Last Updated: Aug 22, 2020

Practice Location

Address: 701 E ALICE
City: Blackfoot
State: Idaho
ZIP Code: 83221-0129
Phone: (208) 785-5826

Authorized Official

Name: ED AXFORD
Title: PROGRAM MANAGER
Phone: (208) 234-7900

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Clinic/Center - Adolescent and Children Mental Health — Adolescent and Children Mental Health	261QM0855X	Primary

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